<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" data-rule="required" class="form-control" name="row[name]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Place_image')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-place_image" data-rule="required" class="form-control" size="50" name="row[place_image]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="plupload-place_image" class="btn btn-danger plupload" data-input-id="c-place_image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-place_image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-place_image" class="btn btn-primary fachoose" data-input-id="c-place_image" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-place_image"></span>
            </div>
            <ul class="row list-inline plupload-preview" id="p-place_image"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Charge_type_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-charge_type_id" data-rule="required" data-source="charge/type/index" class="form-control selectpage" name="row[charge_type_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Place_address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-place_address" data-rule="required" class="form-control" name="row[place_address]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Place_lng')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-place_lng" data-rule="required" class="form-control" name="row[place_lng]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Place_lat')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-place_lat" data-rule="required" class="form-control" name="row[place_lat]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">省市区:</label>
		 <div class="col-xs-12 col-sm-8">
			<div class="form-inline" data-toggle="cxselect" data-selects="province,city,area">
				<select class="province form-control" name="row[province]" data-url="ajax/areaWidthRow"></select>
				<select class="city form-control" name="row[city]" data-url="ajax/areaWidthRow"></select>
				<select class="area form-control" name="row[area]" data-url="ajax/areaWidthRow"></select>
			</div>
		</div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Start')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-start" data-rule="required" class="form-control" name="row[start]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('End')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-end" data-rule="required" class="form-control" name="row[end]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Give_back')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-give_back" data-rule="required" class="form-control selectpicker" name="row[give_back]">
                {foreach name="giveBackList" item="vo"}
                    <option value="{$key}" {in name="key" value=""}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="statusList" item="vo"}
            <label for="row[status]-{$key}"><input id="row[status]-{$key}" name="row[status]" type="radio" value="{$key}" {in name="key" value="0"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
